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Item How do Internal Medicine Residency Program Websites Signal their Inclusion of LGBTQIA+ Applicants in the East North Central Region?(2024-04-26) Gribbin, Will; Baker, Brittany; Peterson, Ellen; Anak Ganeng, Brenda; Byram, JessicaItem MSK PoCUS Training for Rural Clinics(2024-04-26) Smeltzer, Kathryn; Tollar, Roarke; Cook, Myanna; Wilcox, James; Ireland, EllenINTRODUCTION: Point of care ultrasound (PoCUS) is a portable diagnostic technology with broad applicability, no radiation, and is less expensive than alternative imaging methods. PoCUS is emerging as high utility technology to expand bedside physical exams for primary care practitioners. Access to medical care in rural areas is an ongoing issue, especially for specialty care. By using PoCUS, rural providers may be able to more completely screen for conditions and determine if patients will need to seek specialty care, such as orthopedic intervention, which is often more time consuming for rural patients. OBJECTIVES: This study is to identify barriers to learning and using point of care ultrasound technology for rural primary care practitioners for expanded examination, including for orthopedic applications. The secondary objective of this pilot study is to evaluate the best practices of expanding rural PoCUS training. METHODS: The team identified six rural primary care practitioners at outpatient clinics around Indiana. Grant funding was used to equip these clinics with portable ultrasound probes with PoCUS-software-equipped iPads. Training consisted of approximately one hour of independent didactic material and two hours of in-person hands-on training with our investigators and students. Initial surveys were collected before and after the in-person training session. After a few months of individual practice, teleguidence training sessions were offered to the participants. Post-training surveys will be collected approximately six months after the initial training session. At this time, the first and second surveys for the six physicians have been analyzed and provide preliminary results. RESULTS: The pre-training survey from the six physicians before the in-person training session found that previous PoCUS experience of these physicians varies greatly, and nearly all of these practitioners have not used ultrasound in their clinic within the last year. This survey also showed unanimously that these physicians make orthopedic diagnoses in their practice but do not feel comfortable using ultrasound in supporting these diagnoses, showing the potential for PoCUS in their clinical practice. The second survey results have shown that even after just two hours of training, the physicians are comfortable with using ultrasound to support their orthopedic diagnoses, to the point that the majority are also somewhat comfortable teaching this material to others. All of the physicians agreed that the independent didactic material supplemented the in-person training, which supports both the quality and platforms provided for this material. The enthusiasm and improved confidence after the training sessions also support the quality of our investigators’ in-person training sessions. Though it was not difficult to recruit physician participants, one of the biggest obstacles this study faced was scheduling the in-person training session. CONCLUSION: Implementation of PoCUS in rural clinics for the evaluation of orthopedic diagnosis was met with enthusiasm and has shown potential for streamlining evaluation at specialty clinics. Major barriers to adopting this technology include finding adequate time for medical practitioners to learn and practice using the equipment and scheduling live, on-going training.Item Assessing a Longitudinal Educational Experience for Continuous Quality Improvement(Indiana University School of Medicine Education Day, 2024-04-26) Masseria, Anthony; Birnbaum, Deborah R.This presentation explores the use of assessment tools to promote adaptability and continuous quality improvement (CQI) in a large educational program. The Scholarly Concentrations Program is a statewide program complementing the core medical school curriculum and empowering students to delve into topics of personal interest. The pilot was launched with a “CQI” mindset, and after three years, a robust assessment plan is gathering feedback. While “building the plane as we fly it”, the program has grown from 100 students in its first year to over 400 in its third. A robust, longitudinal evaluation plan is critical. The intended goal is to use this program example to replicate it with other large educational programs anywhere.Item Empowering Youth: Examining Health Literacy Gains in High School Students(2024-04-26) Grischke, Tyra; Tannir, Shadia; Bohn, Camden; Hoffman, Leslie A.Research Statement/ResearchQuestion This study assesses the health literacy of high school students’ before and after an educational presentation about hypertension, a health condition more prevalent in underserved communities. Background Low health literacy is associated with worse health outcomes, particularly within underserved communities. Improving health literacy among high school students can empower them to take action to improve health and well-being within their communities. Methods In spring 2023, medical students from IUSM visited four high schools to educate students on health literacy and hypertension. Participants completed a 15-item test prior to and immediately following the presentation. Demographic data (grade level, race, ethnicity, and gender) was collected. Data was collected anonymously, using assigned codes to match pre- and post-tests. Data was analyzed using paired samples t-tests and ANOVA. Results A total of 104 high school students completed pre- and post-tests. There was a significant improvement in quiz scores from pre- (7.95±1.74) to post-test (9.41±2.01; p<.001). One-way ANOVA found significant differences in pre- and post-test performance based on race, with Black students scoring lower than White students on both pre-test (7.28±1.28 vs. 8.31±1.70; p<.05) and post-test (8.55±2.21 vs. 9.85±1.76; p<.05). There was also a significant interaction between students’ gender and their pre- and post-test scores with female students showing greater improvements in test scores than male students. Limitations This study was conducted in a single school district in a small midwestern city and may not be generalizable to larger urban or rural populations. The presentation was given during a science class and may have been biased by students’ prior knowledge. Differences among presenters may also impact students’ comprehension. Conclusion High school students’ health literacy improved after an educational presentation on hypertension. This study revealed racial disparities in health literacy, highlighting the need for more health education in schools that have more students from underserved racial and ethnic groups.Item What Kind of AI Users Are There?(2024-04-26) Jones-VanMieghem, Cassandra; Papandreou, Amanda; Dolan, LeviINTRODUCTION • The field of Human-Computer Interaction (HCI) has long used the technique of personas in theory and practice to enhance human-centered design (Chang et al., 2008). • Generative AI (GenAI) introduces new HCI issues due to inherent generative variability (Muller et al., 2023) and shifts in the meaning of control (Geyer et al., 2024). • The effects of this variability are part of the ongoing discussion about the role of emotion in HCI (Wadley et al., 2022), and are being felt across various domains such as education, biomedical research, and administrative tasks. • Persona development in GenAI HCI is a design technique that can be adapted to student and professional development to potentially improve learner and user experience. OBJECTIVES • To identify characteristics of GenAI interactions in library consultations, instruction sessions, and trainings. • To propose an initial theoretical HCI persona framework for AI users, focused on users of health systems-related AI applications. METHODS • We collectively wrote reflections on the utilization of AI and attitudes of the medical students, staff, and faculty that we encountered on the job from November 2023-January 2024 . • We attended various AI professional development sessions from November 2023-April 2024 , during which we took notes regarding the types of questions posed by attendees to capture prevalent concerns and interests. • We discussed our consolidated observations and identified major attitudinal themes. • We developed a Four-Persona Framework to categorize these themes. • We searched for points of contact with these themes in recent HCI and medical literature as an initial exploration of the framework’s generalizability. RESULTS Four Persona Framework • Unconscious User (Don’t know/Don’t care) o Survey of general US public found that they believe humans make better decisions than AI (5 studies n=<1000; Dietvorst et al., 2014). o Survey of emergency and trauma surgeons worldwide found that 73.3% could not define a list of AI-related terms (n=200; De Simone et al., 2022). o Survey of radiation oncologists and medical students in China found that they were favorable toward using AI in healthcare systems due to reduced workloads, unlike the public’s centering of risk/intent in usage choice (Zhai et al., 2021) • Avoidant User (Dangerous) o Survey takers from the general US public who indicated a low level of mistrust of human decision makers mistrusted AI more than humans (n=187; Lee & Rich, 2021) o Survey of physicians in Germany found that 48.2% agreed that using AI prevents doctors from learning how to correctly assess a patient (n=294; Maassen et al., 2021) o Survey of medical and dental students in 63 countries found that 43.2% disagree that AI will never make a human physician expendable (n=3,133; Bisdas et al., 2021) • AI Enthusiast (Beneficial) o Interviews with study volunteers in the Netherlands found that they generally expected AI to perform accurately (n=14; Jeung & Huang, 2023). o Survey of medical and dental students in 63 countries found that 83.9% think AI will be revolutionizing for medicine and dentistry. This view was most strongly held by male students from a developed country (n=3,133; Bisdas et al., 2021). o Survey of emergency and trauma surgeons worldwide found that 86% thought AI will improve acute care surgery (n=200; De Simone et al., 2022). • Informed AI User (Empowered) o Users of mobile health apps in Switzerland reported that they were more likely to trust apps that included medical certification, anonymization of data, and were affiliated with a trusted hospital system (n=106; Baldauf et al., 2020). o Survey of medical and dental students in 63 countries found that 85.6% think AI training should be a core part of medical training curriculum (n=3,133; Bisdas et al., 2021). o Survey of the general US public observed that there are important differences in how social groups perceive AI. Sizeism, transphobia, ableism, sexism, racism, and other factors influence AI-related medical experiences (n=187; Lee & Rich, 2021). CONCLUSIONS • The proposed Four Persona Framework can interpret many cases of expressions of human attitudes in HCI studies, including examples related to medical education. • Human attitudes are often more complex than any one persona, and change over time. Therefore, further framework development to accommodate multiple personas with varying intensities would make this framework more robust (see quandrant graphic) . • A future direction for framework development would be a qualitative or mixed methods study to test the proposed personas, identify gaps, and their prevalence in specific medical student, professional, and community populations.Item How are our Undergraduate Students Doing? Exploring the Emotional Impact of Human Donors in Undergraduate Anatomy Education(2024-04-26) Shafer, Anna; Dunham, Stacey M.INTRODUCTION: The use of human cadavers (donors) in anatomy laboratories is a common experience for many future healthcare professionals. For undergraduates taking anatomy, this may be their first introduction to human cadavers, and for many students their first experience viewing a deceased person. Students exhibit a variety of reactions to this experience. Previous research has focused on student experiences in undergraduate medical education. This study explores student reactions to donors in undergraduate education. STUDY OBJECTIVE: The purpose of this study was to ascertain students’ emotions and reactions to the donors in the laboratory classroom setting and to identify coping mechanisms that students used within this learning environment. Understanding these student experiences will provide insight to educators as they work to accommodate student needs and understand the emotional impact of human donor use in undergraduate education. METHODS: The participants of this study included students who completed a 5-credit hour, 200-level human anatomy course between Fall 2021 through Fall 2023. The laboratory uses two prosected donors that the students observe throughout the semester. Students are required to identify structures on the donors for the muscular, nervous, circulatory, respiratory, digestive, urinary, and reproductive systems. Students do not have the opportunity to touch the donors; instead, instructors in the course demonstrate structures to small groups of students, and students can practice identifying structures during open study periods. Three of the four laboratory exams include identification questions on the donors which are approximately 25% of each exam. Students who were currently enrolled in the course, as well as those who were previously enrolled, were invited to participate in the study via the university’s learning management system. Students completed an anonymous survey that asked questions related to their individual experiences in the anatomy laboratory. The survey was hosted on Qualtrics and completed by participants electronically. The study was approved by Indiana University IRB #21296. RESULTS: A total of 326 surveys were completed. For 88% of students, this was their first exposure to human cadavers. Students described feeling excited, nervous, frightened, awed, shocked, and hesitant upon first seeing the donors. Only 22% of students somewhat or strongly agreed with the statement, “I believe using humor is an appropriate coping method for working with the donors.” When asked if they “would have benefitted from knowing more information about the lives of the donors,” 30% of students responded they either somewhat or strongly agreed. Students frequently described reminding themselves the donor was previously a living being as a coping mechanism. Many students also discussed the importance of eating before lab. CONCLUSIONS: While the initial exposure to human donors in the anatomy laboratory can be an unsettling experience for students, anatomy educators can accommodate their students' emotional needs by using appropriate instruction methods. This can provide a positive learning environment and potentially result in an improvement in students’ performances within the course as well as future anatomy education.Item Self-Stigma vs. Perceived Public Stigma Toward Mental Illness in Rural Adults(2024-04-26) McCreary, Brent; Danek, Robin; Ireland, Ellen; Reyes, EricIntroduction: Mental illness is a clinically significant behavioral or psychological condition1. Stigma toward mental health comes in two primary forms: Self-stigma and perceived public stigma. Purpose: The objective of this study is to quantify the amount of stigma toward mental illness in rural adults and analyze differences in stigma across demographic groups. Methods: Adults were offered a 14-item questionnaire at five different sites from January 2023 to April 2023. Rural distinctions were made based on participants' reported county of residence following the Indiana Office of Community and Rural Affairs (OCRA) definition of rurality. Demographic information such as age, gender, marital status, total household income, and highest level of education were also obtained. Results: Rural adults experience mild amounts of self-stigma (14.52 +/- 5.0) and moderate amounts of perceived public stigma (18.4 +/- 4.3). Adults aged 46-65 experience more significant levels of perceived public stigma when compared to those of younger participants. An inverse relationship exists between the highest level of education and self-stigma towards mental illness. Seventy two percent of respondents agreed or strongly agreed with the statement, “In general, others believe that having a mental illness is a sign of personal weakness or inadequacy.” Conclusions: This study demonstrates that perceived public stigma toward mental illness presents a significant barrier to care for mental illness. Adults aged 46-65 are especially vulnerable to the perceived public stigma toward mental illness. To provide the largest benefit to rural populations, anti-stigma campaigns should focus on perceived public stigma among adults aged 46-65.Item Applying Cyclical Loading Parameters for In-Vitro Neo-Tendon Development(2024-04-26) Darden, Faith; Jenkins, Thomas; Little, DianneINTRODUCTION: Annually, over 545,000 rotator cuff tear repairs occur in the USA. Current surgical methods have varied success, due to factors including tear size and patient age. The fibrotic tissue that results from repair is susceptible to re-tear: retear rate following repair is up to 94% for large tears. There is a need for better treatment. Tissue engineering is a potential solution. Poly(lactic acid) meltblown scaffolds produce neotendon but cannot withstand physiological strains. Here, we evaluate how cyclical tensile loading of poly(ε-caprolactone) (PCL) meltblown scaffolds affects neo-tendon development. METHODS: We seeded PCL with human adipose stem cells and cultured for 28 days with cyclic loading to 6% strain three times per week for 0, 125, 5,000, and 10,000 cycles/day using a tensile bioreactor. We characterized the viscoelastic mechanical properties using this protocol: preconditioning, hysteresis loops and 10 min stress relaxations at 1, 3, 5, and 7% strain, each followed by frequency sweeps at 0.1, 1, and 5 Hz, and a ramp-to-failure. We determined various parameters using custom MATLAB code. Data were evaluated for effect of loading using ANOVA with Tukey HSD post-hoc tests (n=3-5, α=0.05). RESULTS: Loading at 5,000 cycles (Fig. 1) improved sample linear modulus and yield stress compared to other loading groups, while increased loading led to decreased yield stretch. Samples loaded at 5,000 cycles had higher phase shifts at lower frequencies, suggesting greater stress dissipation. Stress relaxation decreased from 3% strain to 5% and 7% strain. There was no effect of loading on stress relaxation. Loading up to 5,000 cycles tended to increase energy storage and secant stiffness but dropped when increased to 10,000 cycles. CONCLUSION: Tendon viscoelastic properties are essential for their mechanical stability and function; scaffolds with similar mechanical function could improve repair. Tensile loading during culture improves mechanical function up to 5,000 cycles/day but loading at 10,000 cycles/day seems to cause damage to the fibers, reducing modulus, yield stretch, yield stress, stiffness, and energy storage at higher strains. Our data will establish if meltblown scaffolds are viable for preclinical studies and could inform rehabilitation protocols for engineered tendon development.Item Use of Artificial Intelligence Program to Increase Resident Confidence and POCUS Use at the Bedside(2024-04-26) Wilcox, James; Lobo, Daniela; Hernandez, Reuben; Holley, Matthew; Renshaw, ScottIntroduction: Point of Care Ultrasound (POCUS) education continues to increase in undergraduate and graduate medical education, mostly fueled by clinical usefulness and increasing graduate medical education requirements. Many schools are now teaching POCUS as a core part of the curriculum. However, with the sudden rush of POCUS education, one barrier often identified in the literature is a lack of trained faculty to educate residents and medical students. Study Objective: Our team at the Family Medicine Department recruited an artificial intelligence program developed by Global Ultrasound Institute to assist POCUS instructors with resident ultrasound education. The research project would use AI programming and learning to allow residents to access timely answers to questions at the bedside while on rounds, when a trained POCUS instructor might not always be present. Since POCUS instructors cannot be available for every bedside patient examination in the hospital or residency clinic, this AI program would provide answers to needed bedside questions to give residents more confidence with performing more POCUS evaluations. Methods: We would deploy the AI program for interns who have completed at least 6 months of POCUS training and residents who had completed prior intern POCUS training. This program would be available on smart phone devices for when rounding in adult medicine, pediatrics, OBGYN, and in the outpatient residency clinic. Residents will have 24/7 access to a smart AI who will answer questions about POCUS technique, indications for use, interpretation questions, and many more. The program will give residents a quick and focused answer, as well as access to resources for further study if needed. Resident POCUS use will be tracked with the Butterfly IQ academy, as well as with resident procedure logging. Results: Since this is a very new program and relationship with Global Ultrasound Institute, no results are currently available. We anticipate preliminary results will be available by the presentation date in April. Conclusions: Artificial Intelligence is changing the way medical education is approached in the United States and the world. This particular program will allow residents to have access to timely answers to their POCUS practice questions at the bedside, while on rounds. We anticipate this will allow residents the opportunity to use the ultrasound devices for more cases and scenarios, as well as have improved confidence in their ultrasound acquisition abilities, with the support of the AI Education Assistant.Item The Effect of Large Femoral Heads and Acetabular Cup Position on PROMs after Modern Posterior Approach THA(2024-04-26) Darden, Austin; Deckard, Evan; Meneghini, R. MichaelINTRODUCTION: Use of large femoral heads (≥40mm) in total hip arthroplasty (THA) decreases postoperative dislocation by increasing impingement-free range of motion, however, may leave patients more susceptible to groin pain. Also, limited data exist for the effect of large femoral heads and acetabular cup position on modern patient-reported outcome measures (PROMs). Therefore, the purpose of this study was to evaluate the effect of large femoral heads (≥40mm) and acetabular cup position on PROMs after primary THA. METHODS: 328 primary THAs performed by a single surgeon were retrospectively reviewed. Acetabular cup inclination and anteversion were measured using Martell Hip Analysis Suite software. Femoral head and acetabular cup sizes were recorded from the electronic medical record. Prospectively collected PROMs (and covariates) related to activity level, satisfaction, and overall hip health were evaluated. RESULTS: Age, covariates related to PROMs, and acetabular cup position did not differ between ≥40mm and <40mm femoral head groups (p≥0.177). The ≥40mm head group had significantly higher mean BMI and proportion of males (p≤0.022). UCLA Activity level and satisfaction scores did not differ preoperatively or postoperatively at 4-months or minimum 1-year follow-up between femoral head groups (p≥0.209). Preoperative HOOS JR scores did not differ by femoral head groups (p=0.538). At 4-months, mean HOOS JR score was significantly higher in the ≥40mm head group compared to the <40mm head group (p=0.027); however, both groups achieved similar mean HOOS JR scores by minimum 1-year follow-up (p=0.956). HOOS JR score >90 and being ‘very satisfied or satisfied’ correlated with wide ranges and several combinations of acetabular cup inclination and anteversion. CONCLUSION: Patients achieved comparable PROMs regardless of femoral head size suggesting large femoral heads may not leave patients susceptible to groin pain in addition to reducing the risk of postoperative dislocation. Excellent patient outcomes correlated with wide ranges of acetabular cup position.